When rules defy logic

If the prime minister had the wisdom of the Pakistan Medical and Dental Council (PMDC), he would not have put his trust in his doctor in London. If the PMDC’s rules are anything to go by, the doctor who treated PM Nawaz Sharif at the Harley Street Clinic, London would most likely not be qualified enough to be appointed as a member of faculty at the Haji Abdul Qayyum Government Hospital Sahiwal.

The narrow, lopsided and regressive rules of the PMDC have made it virtually impossible for doctors of Pakistani origin who are trained and working in Europe and the US to return and play a constructive role in bringing much-needed reforms to medical education in the country.

The PMDC has laid down criteria for the appointment of the teaching faculty in medical teaching facilities across the country. These criteria were updated in March 2017. One reading of these criteria is enough to realise that vested interests are out to monopolise and, thereby, keep medical education backward in the country.

The PMDC’s rules lay down a four-tier level of qualifications which are necessary for doctors to be appointments as assistant, associate and full professors. The ideal scenario would be that it would keep its interference to a minimum and restrict its guidelines to these minimum educational qualifications, research work and the basic guidelines regarding experience. However, it goes further and defines ‘teaching experience’ in the most stringent and illogical way. This is where it seeks to shut out highly-trained doctors from abroad.

The new regulations, for example, require that for a doctor to be appointment as a professor at a medical teaching institute, he or she should have at least three years of experience working as an associate professor or nine years working as assistant professor. It also requires that all appointments made for the assistant or associate professor slots should be “substantive and full-time”.

In other words, doctors working in Europe and the US need not apply for any posting senior than an assistant professor in Pakistan, no matter what their degrees from abroad are and regardless of the number of years they have spent working in some of the best hospitals across the world.

The world has since some time now moved beyond the archaic ‘professorial’ system with regard to medical teaching. For example, in the UK, Ireland or the US, most clinical medical teaching is performed by doctors who have no academic titles. Few have honorary or adjunct titles with medical colleges or universities and even fewer have full-time, substantive appointments at these institutions. They are not even attached to medical colleges in a formal way. This system works well for countries with some of the best healthcare systems in the world. But it has been deemed unacceptable by the PMDC for Pakistan and its decadent medical education system.

These consultants in the UK or Ireland, without holding any academic appointments, train some of the best doctors in the world. They prepare doctors training at the postgraduate level for some of the toughest professional examinations, such as the MRCP or the MRCS/FRCS. They also supervise specialist registrars for further advanced training. The regulatory bodies in the developed world would have no problems with this system, but the PMDC does.

A consultant who may have trained hundreds of specialist doctors in the UK or Ireland over the course of 10 or 20 years in the best hospitals in the world and also has research publications to his name but no academic title, stands little or no chance of being appointed as an associate or full professor in Pakistan according to PMDC’s rules. At best, he or she can hope for appointment at the bottom of the ladder as an assistant professor. On the other hand, someone with ‘experience’ as either an assistant or an associate professor or even as a district specialist in a DHQ hospital in Charsadda or Mansehra would be eligible.

In the US, there are even fewer doctors who hold full-time, substantive academic appointments. The continuing medical education requirements in the US are some of the most stringent in the world. This means that most doctors are engaged in some form of teaching and learning throughout their careers.

These doctors, who train residents and fellows at the most advanced levels, may not have any academic appointments. This is good for a first-world country like the US but not for Pakistan, according to the PMDC’s rules.

It is ironic that the PMDC recognises postgraduate qualifications, such as the MRCP or the MRCS diplomas, the residency and fellowship training requirements and subsequent American Board qualifications. But the council refuses to recognise experience of the doctors who are imparting this training. If the teacher is no good and is not recognised, why are the qualifications of their trainees recognised?

The Higher Education Commission (HEC) under Dr Atta-ur-Rehman brought revolutionary changes to higher education in Pakistan. It laid down criteria for appointments at universities and colleges in Pakistan. These criteria are inclusive and meant to welcome the best talent from across the world.

The HEC criteria are in conformance with the realities of life in the developed world. For most fields, the criteria recognise professional experience in the relevant field in a national or international organisation. Unfortunately, the HEC was made to cede to the PMDC regarding the rules on medical education. The monopolistic mindset at the PMDC persisted with the old, restrictive rules.

Few disagree that the medical education system in Pakistan needs to be revamped. It needs to be infused with fresh ideas. However, the PMDC’s rules all but shut the door on importing these ideas. It has merrily closed its eyes to the world and appears to be comfortable within its own cocoon.

For a multitude of rather valid reasons, it is difficult to convince doctors who are working abroad to relocate to Pakistan. If some brave medical professionals are somehow convinced to do so, the PMDC exists to ensure that it has enough roadblocks in place to frustrate these efforts.

It is time the PMDC wakes up to the realities and challenges of the 21st century. Its failures in regulating the medical profession can be seen by all. It should at least spare medical education. The best-case scenario would be to do away with the hierarchical ‘professorial system’ for clinical subjects altogether and embrace the positive changes that have been put in place in the developed world.

At a minimum, the PMDC needs to adopt the inclusive and progressive criteria that the HEC has for faculty appointments in other fields. The option of delegating the responsibility for medical education to the HEC instead of the PMDC should also be debated afresh.

If an engineer is considered suitable for faculty appointment based on his or her professional experience in a national or international organisation, why is a doctor who has gained the most advanced form of training and has worked in some of the best hospitals in world not qualified for our medical teaching institutes? The PMDC needs to explain this logic. Can it tell us on what basis it rates the work experience at the DHQ Hospital in DG Khan superior to work experience at any hospital in the UK? It owes the nation and also the prime minister an explanation.

The writer is a former president of the Association of Pakistani Cardiologists of North America (APCNA). He tweets @spaelanay.

Email: arshadrehan@hotmail.com